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NPI Code Detail

MEDICARE: DR. AUDRA JOYCE REITER MD, MPH

MEDICARE: DR. AUDRA JOYCE REITER MD, MPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician036155497IL
2208600000XSurgery Physician84944-20IL

General Provider Information

NPI Number : 1770087454
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AUDRA JOYCE REITER MD, MPH
Provider Business Mailing Address
First Line : 2650 RIDGE AVE # 1223
Second Line :
City : EVANSTON
State : IL
Zip : 60201-1700
Country : US
Telephone Number : 847-982-3175
Fax Number : 847-982-3394
Provider Business Practice Location Address
First Line : 880 W CENTRAL RD STE 5000
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60005-2384
Country : US
Telephone Number : 847-618-3800
Fax Number : 847-618-3809
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2018
Last Update Date : 06/02/2026

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